Written Evidence Submitted by Professor Rachel Cooper at Newcastle University (HAP0059)

 

 

 

 

HEALTHY AGEING: PHYSICAL ACTIVITY IN AN AGEING SOCIETY

Written evidence submitted by the AGE Research Group at Newcastle University

 

Dr Christopher Hurst, Professor Rachel Cooper, Dr Antoneta Granic, Professor Miles D Witham and Professor Avan Aihie Sayer

 

  1. The AGE Research Group is based within the Translational and Clinical Research Institute, Faculty of Medical Sciences at Newcastle University. We are an interdisciplinary team comprising geriatricians, life course epidemiologists, gerontologists, statisticians and sport and exercise scientists and we work in partnership with patients and members of the public to improve lives through world-class research in ageing, sarcopenia and multiple long-term conditions (MLTC).

 

  1. The AGE Research Group leads the Ageing, Sarcopenia and Multimorbidity Research Theme within the National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre (Director: AA Sayer). This theme aims to translate understanding of fundamental ageing processes into advances in the prevention, diagnosis and treatment of common age-related conditions including sarcopenia and MLTC.1

 

  1. Our programme of work encompasses detailed observational studies to characterise muscle health and MLTC across the life course, novel experimental medicine platform trials to evaluate interventions, and innovative programmes focused on delivering effective implementation, ensuring that research breakthroughs in ageing, sarcopenia and MLTC result in benefits for patients and the public. At all stages along this translational pathway, we are undertaking research on physical activity in recognition of its important roles in the promotion of healthy ageing and in the prevention and mitigation of age-related conditions.

 

  1. For the purposes of this submission, we have drawn primarily on the AGE Research Group’s own work, while acknowledging the wider literature.

 

What are the opportunities in public health to promote physical activity to prevent physical and mental ill health at a population-level as people begin to age and help them remain healthy into older age? How can this be delivered?

 

  1. The myriad public health benefits of physical activity across life, including for the promotion of healthy ageing, are well recognised.2–4

 

  1. In identifying opportunities to translate epidemiological evidence on the health benefits of physical activity cited in national and international reports into public health interventions focusing on the promotion of healthy ageing we need to take a life course approach. Our group and others have presented evidence showing that: a) there are cumulative benefits of participating in leisure time physical activity across life to develop and maintain physical function5,6; b) despite cumulative benefits of physical activity across life, there is also evidence that it is never too late to intervene and achieve benefits7,8; c) ageing is a lifelong process and retaining sufficient physical and cognitive function in later life to remain active and independent requires promotion of the development of peak function from childhood to early adulthood, maintenance of function throughout mid-adulthood and prevention of decline in later adulthood.9

 

  1. Opportunities to promote healthy ageing via physical activity interventions exist at each stage of life.  However, it is important to tailor these interventions to take account of barriers to physical activity that vary by age and health status (see below). It is also important to carefully consider the type and timing of activities that are promoted. There should be recognition that after many years of cumulative exposure to a certain lifestyle, behaviour change is difficult.

 

  1. There is a need to identify those age-related conditions that pose a specific threat to healthy ageing and focus attention on public health strategies that prevent these and/or mitigate their impacts. Sarcopenia, the accelerated loss of skeletal muscle mass and function, commonly but not exclusively associated with advancing age precipitates declines in physical function and mobility and is associated with adverse outcomes including falls, disability and premature mortality.10  Despite an estimated prevalence of between 5 and 10% in the general population our work shows that there is limited awareness of this important condition among the public11 and clinical communities.12 This needs to be addressed in order to achieve more widespread uptake and adoption of the recommendations on strength training already presented within national and international physical activity guidelines. This is especially as there is clear evidence of benefits of resistance exercise for improving muscle strength and physical function alongside evidence that activities to promote cardiorespiratory fitness do not have the same benefits for muscle strength.13,14 This is important given evidence that muscle strengthening activities are not commonly adopted by the general public, especially women, if they are simply encouraged to be more active.

 

  1. Strength training interventions should be prioritised for older people as this is the most effective type of activity for improving muscle strength and physical function. We have developed and published practical guidelines for simple strength training delivery for older people.15 Our research with older people, including those living with frailty and MLTC has shown that they are willing to engage in strength training provided they are appropriately supported.16,17

 

What are the opportunities for health services to promote physical activity to reduce the impacts of ill health and reduce the development of multimorbidity and/or frailty in older people who already have a long-term health condition? How can this be delivered? 

  1. What interventions would have the most impact in reducing the gap in healthy life expectancy between older people living in the most and least deprived regions?

 

  1. Physical activity is a core component of any population level strategy to prevent functional decline and incident MLTC. However, not all physical activity is equally effective especially for the promotion of muscle strength and physical function.18 Our work has illustrated that individuals living with MLTC who have low levels of physical activity are at increased risk of muscle weakness and loss of strength over time19 while higher levels of physical activity are protective of muscle strength loss.20 Targeting physical activity interventions at people living with MLTC should be an important goal for health services. As outlined above, the focus in doing this should be on the promotion of strength training to improve muscle function.

 

  1. There is considerable opportunity for health services to improve older people’s engagement in appropriate physical activity. Previous work has shown that current exercise programmes offered to older people living with sarcopenia and frailty, lack the specificity, frequency or duration of exercise likely to improve outcomes.21 Our ongoing Benchmarking Exercise Programme for Older People (BEPOP) service improvement project aims to support the delivery of strength training to older people living with sarcopenia and frailty.22 Recommendations made to clinicians because of this work have resulted in improvements in the delivery of strength training to older people in clinical practice.

 

  1. Opportunities exist to promote physical activity during different interactions with health services. For example, there is a need to recognise that reduced physical activity, as a result of a declines in health status and hospitalisation, can have negative psychological consequences for patients23 and hospitalised older people engage in very low levels of physical activity.24 This suggests that promotion of appropriate physical activity in hospital settings and during transitions from hospital into the community may be beneficial.

 

  1. Interventions that aim to promote physical activity have the potential to inadvertently exacerbate health inequalities.25,26 This can be addressed by ensuring engagement with relevant evidence-based frameworks in the design and delivery of interventions.27

 

What are the key barriers to older people increasing their physical activity and how can they be encouraged and supported to do more?

 

  1. A range of structural and individual barriers prevent older people from being physically active. Individual (e.g., poor health, pain, fatigue, fear of falling or injury), social (e.g., lack of social support) and environmental factors (e.g., lack of appropriate and accessible programmes and facilities and cost) all influence participation and need to be considered when designing strategies to encourage and support older people to be physically active. Specific barriers to strength training exist which include a lack of awareness, fear of injury and limited access to appropriate training and equipment. Older people have told us that they value supervision from an appropriately trained individual who can support them to engage in strength training safely by overcoming key barriers.16,17

 

  1. Activities that are enjoyable and offer social opportunities are valued by older people.17 Embedding prospects for social interaction into physical activity programmes is important to support engagement. Opportunities to engage in physical activity need to be accessible, both physically and financially, for older people to support them to do more. Greater effort is needed to communicate the benefits of physical activity, especially strength training, to encourage engagement. A one size fits all approach is likely to be suboptimal and programmes need to be tailored to the specific needs of individuals. It is important to remember that older people constitute a broad heterogeneous group, from the robust and healthy to those with severe frailty and physical dependency.

 

  1. For those older adults living with frailty and MLTC, barriers to engagement in physical activity, particularly strength training, are more complex.16 Our work with older people living with MLTC suggests that a focus on strategies that minimise participation burden whilst simultaneously maintaining an adaptive and flexible approach to support participation are likely to be most effective.28

 

How can health services work with social care, the third sector, businesses and local government to support older people to be more physically active and address existing health inequalities?

 

  1. Health services should work with partners including businesses and the third sector (e.g., exercise providers in the community) to support the promotion, awareness raising and delivery of structured physical activity programmes for older people. There should be a focus on strength training and these programmes should be targeted in those areas of highest deprivation. These community-based organisations can have the benefit of being more accessible and may have greater resource to support implementation than is available within the health service. 

 

  1. Health services can learn from recent efforts to support the inclusion of older people in research as parallels exist with supporting the engagement of older people in physical activity programmes. We have shown the importance of working closely with older people in underserved communities to support engagement in research.29 Best practice recommendations to support research inclusion, with involvement from a range of stakeholders, suggest that research should be designed to specifically meet the needs of older people and highlights the need for flexible approaches to promote access.30

 

What progress has been made since the 2019 NHS England Long-Term Plan set out its ambitions to support people to age well and how could it be improved in relation to physical activity?

 

  1. Our work on MLTC in hospitalised populations31, suggests that the prevalence of MLTC, especially among older people, is high and has increased since 2019. These trends in MLTC are contributing to declines in healthy life expectancy and increasing regional health inequalities32,33 and do not provide any evidence of progress.

 

What should the government prioritise in funding allocations for delivering services to support older people to become more active?

 

  1. Funding should be allocated to support older adults to engage in strength training. As well as providing opportunities to engage, funding is needed to support efforts to build awareness of the benefits of strength training for older people. As described above, a lack of awareness and unfamiliarity with strength training can be a significant barrier to engagement. A campaign to build awareness in older people is likely to be a worthwhile investment. As well as targeting older people this awareness building should also target healthcare providers and organisations in the community who interact with older people.

 

  1. Funding is needed for investment in infrastructure including leisure facilities, parks, neighbourhood recreational facilities, and transport opportunities to remove barriers to physical activity for people of all ages including those who are older. In allocating this funding it is important to recognise that support is required for interventions that are specifically designed to meet the needs of older people and promote engagement in certain types of activity.

 

 

 

 


References

 

1.              Sayer AA. Harveian Oration 2024: From bench to bedside and beyond – new horizons for translational ageing research. Clin Med. 2025;25(4):100334. doi:10.1016/j.clinme.2025.100334

2.              Department of Health and Social Care. Physical Activity Guidelines: UK Chief Medical Officers’ Report. DHSC; 2019.

3.              World Health Organization. WHO Guidelines on Physical Activity and Sedentary Behaviour. Geneva: World Health Organization; 2020.

4.              Health Select Committee. The Impact of Physical Activity and Diet on Health. UK Parliament; 2015.

5.              Dodds R, Kuh D, Aihie Sayer A, Cooper R. Physical activity levels across adult life and grip strength in early old age: updating findings from a British birth cohort. Age Ageing. 2013;42(6):794-798. doi:10.1093/ageing/aft124

6.              Cooper R, Mishra GD, Kuh D. Physical Activity Across Adulthood and Physical Performance in Midlife. Am J Prev Med. 2011;41(4):376-384. doi:10.1016/j.amepre.2011.06.035

7.              Pahor M, Guralnik JM, Ambrosius WT, et al. Effect of Structured Physical Activity on Prevention of Major Mobility Disability in Older Adults: The LIFE Study Randomized Clinical Trial. JAMA. 2014;311(23):2387-2396. doi:10.1001/jama.2014.5616

8.              Granic A, Davies K, Dodds RM, et al. Factors associated with change in self-reported physical activity in the very old: The Newcastle 85+ study. PLoS ONE. 2019;14(7):e0218881. doi:10.1371/journal.pone.0218881

9.              Dodds RM, Syddall HE, Cooper R, et al. Grip Strength across the Life Course: Normative Data from Twelve British Studies. Vina J, ed. PLoS ONE. 2014;9(12):e113637. doi:10.1371/journal.pone.0113637

10.              Sayer AA, Cooper R, Arai H, et al. Sarcopenia. Nat Rev Dis Primers. 2024;10(1):1-16. doi:10.1038/s41572-024-00550-w

11.              Lewis EG, Hurst C, Errington L, Sayer AA. Perceptions of sarcopenia in patients, health and care professionals, and the public: a scoping review of studies from different countries. Eur Geriatr Med. 2025;16(1):99-113. doi:10.1007/s41999-024-01132-5

12.              Offord NJ, Clegg A, Turner G, Dodds RM, Sayer AA, Witham MD. Current practice in the diagnosis and management of sarcopenia and frailty – results from a UK-wide survey. JFSF. 2019;4(3):71-77. doi:10.22540/JFSF-04-071

13.              Strain T, Fitzsimons C, Kelly P, Mutrie N. The forgotten guidelines: cross-sectional analysis of participation in muscle strengthening and balance & co-ordination activities by adults and older adults in Scotland. BMC Public Health. 2016;16(1):1108. doi:10.1186/s12889-016-3774-6

14.              Norris T, Cooper R, Garfield V, Hamer M, Pinto Pereira SM. Unpicking Causal Relationships Between Grip Strength and Cardiorespiratory Fitness: A Bidirectional Mendelian Randomization Study. Scand J Med Sci Sports. 2024;34(12):e14775. doi:10.1111/sms.14775

15.              Hurst C, Robinson SM, Witham MD, et al. Resistance exercise as a treatment for sarcopenia: prescription and delivery. Age Ageing. 2022;51(2):afac003. doi:10.1093/ageing/afac003

16.              Hurst C, Dismore L, Granic A, et al. Attitudes and barriers to resistance exercise training for older adults living with multiple long-term conditions, frailty, and a recent deterioration in health: qualitative findings from the Lifestyle in Later Life – Older People’s Medicine (LiLL-OPM) study. BMC Geriatr. 2023;23(1):772. doi:10.1186/s12877-023-04461-5

17.              Dismore L, Hurst C, Sayer AA, Stevenson E, Aspray T, Granic A. Study of the Older Adults’ Motivators and Barriers Engaging in a Nutrition and Resistance Exercise Intervention for Sarcopenia: An Embedded Qualitative Project in the MIlkMAN Pilot Study. Gerontol Geriatr Med. 2020;6:233372142092039. doi:10.1177/2333721420920398

18.              Hurst C, Sayer AA. Improving muscle strength and physical function in older people living with sarcopenia and physical frailty: Not all exercise is created equal. J R Coll Physicians Edinb. 2022;52(2):166-171: doi:10.1177/14782715221104859

19.              Hurst C, Murray JC, Granic A, et al. Long-term conditions, multimorbidity, lifestyle factors and change in grip strength over 9 years of follow-up: Findings from 44,315 UK biobank participants. Age Ageing. 2021;50(6):2222-2229. doi:10.1093/ageing/afab195

20.              Granic A, Davies K, Jagger C, Kirkwood TBL, Syddall HE, Sayer AA. Grip Strength Decline and Its Determinants in the Very Old: Longitudinal Findings from the Newcastle 85+ Study. PLoS ONE. 2016;11(9):e0163183. doi:10.1371/journal.pone.0163183

21.              Witham MD, Chawner M, De Biase S, et al. Content of exercise programmes targeting older people with sarcopenia or frailty – findings from a UK survey. JFSF. 2020;5(1):17-23. doi:10.22540/JFSF-05-017

22.              Caulfield L, Arnold S, Biase SD, et al. The Benchmarking Exercise Programme for Older People (BEPOP): Design, Results and Recommendations from The First Wave of Data Collection. JFSF. 2024; 9(3):169-183. doi: 10.22540/JFSF-09-169

23.              Dismore L, Taylor L, Hurst C, Aujayeb A, Poulter H, Swainston K. Experiences of Physical Activity in Mesothelioma: A Qualitative Enquiry. J Respir. 2024;4(4):188-197. doi:10.3390/jor4040017

24.              Lim SER, Dodds R, Bacon D, Sayer AA, Roberts HC. Physical activity among hospitalised older people: insights from upper and lower limb accelerometry. Aging Clin Exp Res. 2018;30(11):1363-1369. doi:10.1007/s40520-018-0930-0

25.              Lorenc T, Petticrew M, Welch V, Tugwell P. What types of interventions generate inequalities? Evidence from systematic reviews. J Epidemiol Community Health. 2013;67(2):190-193. doi:10.1136/jech-2012-201257

26.              White M, Adams J, Heywood P. How and why do interventions that increase health overall widen inequalities within populations? In: Babones SJ, ed. Social Inequality and Public Health. Policy Press; 2009. doi:10.1332/policypress/9781847423207.003.0005

27.              Davey F, McGowan V, Birch J, et al. Levelling up health: A practical, evidence-based framework for reducing health inequalities. Public Health Pract. 2022;4:100322. doi:10.1016/j.puhip.2022.100322

28.              Dismore L, Hurst C, Granic A, et al. Why are older adults living with the complexity of multiple long-term conditions, frailty and a recent deterioration in health under-served by research? A narrative synthesis review of the literature. JFSF. 2023;8(4):230-239. doi: 10.22540/JFSF-08-230

29.              Hurst C, Dismore L, Granic A, et al. The feasibility and acceptability of engaging older adults living with multiple long-term conditions, frailty, and a recent deterioration in health in research: Findings from the Lifestyle in Later Life – Older People’s Medicine (LiLL-OPM) study. BMC Geriatr. 2024;24(1):831. doi:10.1186/s12877-024-05406-2

30.              Goodwin VA, Low MSA, Quinn TJ, et al. Including older people in health and social care research: best practice recommendations based on the INCLUDE framework. Age Ageing. 2023;52(6):afad082. doi:10.1093/ageing/afad082

31.              Witham MD, Bartle V, Bellass S, et al. Building ADMISSION – A research collaborative to transform understanding of multiple long-term conditions for people admitted to hospital. J Multimorb Comorb. 2025;15:26335565251317940. doi:10.1177/26335565251317940

32.              Steel L, Stiebahl S, Lally C. Geographical differences in healthy life expectancy. Parliamentary Office of Science and Technology; 2025.

33.              Bambra C, Davies H, Munford L, Taylor-Robinson D, Pickett K. Woman of the North: Inequality, Health and Work. Health Equity North: Northern Health Science Alliance; 2024.